Study objectives: To examine the current clinical
spectrum of noncardiogenic pulmonary edema (NCPE) related to heroin
Design: Retrospective chart review of all
identified patients from August 1994 through December 1998.
Setting: Urban academic hospital.
participants: Heroin-related NCPE was defined as the syndrome in
which a patient develops significant hypoxia (room air saturation< 90% with a respiratory rate > 12/min) within 24 h of a
clinically apparent heroin overdose. This should be accompanied by
radiographic evidence of diffuse pulmonary infiltrates not attributable
to other causes, such as cardiac dysfunction, pneumonia, pulmonary
embolism, or bronchospasm, and which resolve clinically and
radiographically within 48 h.
Measurements and results: Twenty-seven patients
were identified during this 53-month period, with a majority being male
patients (85%; average age, 34 years). Twenty patients (74%) were
hypoxic on emergency department arrival, and 6 patients (22%) had
symptoms develop within the first hour. One patient had significant
hypoxia develop within 4 h. Nine patients (33%) required
mechanical ventilation, and all intubated patients but one were
extubated within 24 h. Eighteen patients (66%) were treated with
supplemental oxygen alone. Hypoxia resolved spontaneously within
24 h in 74% of patients, with the rest (22%) resolving within
48 h. Twenty patients (74%) had classical radiograph findings of
bilateral fluffy infiltrates, but unilateral pulmonary edema occurred
in four patients (15%) and more localized disease occurred in two
Conclusion: NCPE is an infrequent
complication of a heroin overdose. The clinical symptoms of NCPE are
clinically apparent either immediately or within 4 h of the
overdose. Mechanical ventilation is necessary in only 39% of patients.
The incidence of NCPE related to heroin overdose has decreased
substantially in the last few decades.